Preparing for the impact of Brexit on health in the UK

The consequences of the United Kingdom’s departure from the European Union (EU) will be wide-ranging. As a member of the EU for over 40 years, the UK is fully linked with Europe in all sectors of its society. This includes the UK’s life sciences sector, which faces major risks if it fails to address the challenges that Brexit poses.

The UK’s life sciences sector includes the National Health Service (NHS), the UK’s universities and medical schools, the pharmaceutical sector, and the medical devices industry. With over one million employees, and an annual spend of over £100 billion, the NHS is England’s largest employer.

For many decades, the NHS has faced shortages in its clinical workforce and has relied heavily on overseas trained doctors, nurses and other health professionals to fill these gaps. This reliance on overseas-trained staff will not end in the foreseeable future. For example, although the Secretary of State for Health, Jeremy Hunt, has announced that the government will support the creation of an additional 1,500 medical student places in England’s medical schools, it will be over 10 years before these students complete their medical courses and their subsequent post-graduate medical training.

The recruitment of overseas-trained health professionals has been facilitated by EU legislation on the mutual recognition of the training of health professionals. This means that health professionals trained in one EU country can work in another EU country without undergoing a period of additional training. For example a cardiologist or general practitioner trained in Germany would be eligible to take up a post in the UK’s NHS. Moving forwards, it’s unclear that this cross-EU recognition of clinical training will continue.

There are some in the UK who see clinical training here as ‘superior’ to that in other EU countries and view Brexit as an opportunity to implement tougher employment checks on EU trained health professionals. As inward migration to the UK looks to be the most politically-contentious area in our post-Brexit future, it’s clear we will need to take urgent action to ensure that the NHS has sufficient professional staff to provide health and social care for our increasingly ageing population.

The UK’s government will also have to address the issue of access to healthcare, both for EU nationals living or visiting the UK and UK nationals living overseas in countries such as Spain. Currently, all these individuals are entitled to either free or low cost healthcare.

It’s unclear what will happen in the future and this is particularly important for the elderly, retired UK nationals living overseas, who will have a high need for health care. As the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding healthcare are put in place.

The other vital area of the UK’s life sciences sector is our pharmaceutical industry. Pharmaceuticals are an area where the UK is a world-leader in research, development and production. The leading role that the UK plays in the pharmaceutical sector is facilitated by the location in London of the European Medicines Agency (EMA).

This encourages pharmaceutical companies to use London and the south east of England as their base of operations. With the EMA now looking to relocate out of the UK, there is a significant risk that that some pharmaceutical companies may follow them – with adverse consequences for research and development, as well as the employment of skilled scientific staff, in the UK. Similar issues apply to the medical devices and software industry, another area where the UK has a major international presence.

Another important area for the UK’s government to consider is our involvement in future Europe-wide public health initiatives. These cover many areas including food regulations, road safety, air pollution, tobacco control, and chemical hazards; and are important when dealing with cross-national issues that do not stop at a country’s boundaries (e.g. air pollution). Although such initiatives have had important positive effects on health in the UK, there is strong resistance from pro-Brexit politicians in participating in such programmes, as they generally view them as unnecessary interference in the UK’s internal affairs.

For the UK’s medical schools, Brexit poses risks to the recruitment of research staff from the EU. Like our premier league football clubs, our universities expect to be able to recruit high-calibre academics from the EU, something which they see as essential in maintaining the high rankings of the UK’s universities in international league tables of university performance. There will also be a loss of research funding from the EU and the ability to lead multi-national EU-funded research programmes, and a threat to our participation in the ERASMUS Student Mobility Programme.

We will also need to consider if and how we continue to take part in the Bologna Process – the set of agreements between EU countries which ensure comparability in the standards and quality of higher education qualifications. Linked to these developments is a risk that students from the EU may be less likely to apply to study at UK universities, particularly if their fees increase to the very high level levels currently paid by overseas students from outside the EU.

In conclusion, Brexit will have important impacts on the UK’s life sciences sector, with scope for wide-ranging adverse consequences for health and wealth in the UK. It’s therefore essential that the NHS, the life sciences industry in the UK, and our medical schools engage with government to ameliorate these risks, and to gain public support in areas such as the benefits of participation in EU-wide public health programmes, and the continued recruitment of clinical and scientific staff from the EU.